| NPI | 1629170378 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN MN2609) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ND 556) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2012-04-17 |